Postoperative rupture of an artery dissected from a cerebral aneurysm dome following clipping: A rare and fatal complication.

Jiwon Jung, Young Ha Kim, Pil Soo Kim, Jun Kyeung Ko
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引用次数: 0

Abstract

The adhesion of arteries to aneurysm domes can pose significant technical challenges during surgical clipping. Dissection of these vessels carries a risk of iatrogenic wall damage and subsequent complications. We present the case of a 67-year-old woman with three unruptured intracranial aneurysms. Following successful coil embolization of a right posterior communicating artery aneurysm, surgical clipping was planned for the remaining left middle cerebral artery and anterior choroidal artery aneurysms. Intraoperatively, the M2 inferior division was found to be densely adherent to an aneurysm located at the bifurcation of the M2 superior division. After temporary clipping of the parent artery, careful dissection was performed, and the aneurysm was successfully clipped. Postoperatively, the patient failed to regain consciousness. A computed tomography scan revealed diffuse subarachnoid hemorrhage, and subsequent angiography confirmed active contrast extravasation from the dissected M2 inferior division. The family declined reoperation, and the patient subsequently expired after brain death was declared. This case illustrates that in instances of strong arterial adhesion, extreme caution is warranted during dissection. Even without evident intraoperative bleeding, subtle vessel wall injury can lead to fatal delayed rupture. Meticulous inspection and, when necessary, reinforcement of dissected arterial segments is crucial to prevent such devastating outcomes.

术后从脑动脉瘤穹丘上剥离的动脉在夹闭后破裂:一种罕见而致命的并发症。
动脉与动脉瘤圆顶的粘连在外科手术中构成了重大的技术挑战。这些血管的剥离有医源性壁损伤和随后并发症的风险。我们提出的情况下,67岁的妇女三个未破裂的颅内动脉瘤。在成功栓塞右侧后交通动脉瘤后,计划对剩余的左侧大脑中动脉和前脉络膜动脉瘤进行手术夹闭。术中,M2下分支被发现紧密附着在位于M2上分支的动脉瘤上。在暂时夹住母动脉后,进行仔细的解剖,成功夹住动脉瘤。术后,患者未能恢复意识。计算机断层扫描显示弥漫性蛛网膜下腔出血,随后的血管造影证实从剥离的M2下分区活动性造影剂外渗。家属拒绝再次手术,患者随后在宣布脑死亡后死亡。本病例说明,在动脉粘连较强的情况下,解剖时要格外小心。即使没有明显的术中出血,细微的血管壁损伤也可能导致致命的延迟破裂。仔细检查并在必要时对剥离的动脉段进行加固是防止这种毁灭性后果的关键。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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